Effect of anxiety on posttraumatic stress symptoms and fear of recurrence in patients with barest cancer: the mediating role of fatigue

Anxiety about cancer recurrence is identified as the most common psychological burden experienced by cancer patients and survivors. The present study aimed to assess the mediating role of fatigue in the effect of anxiety on posttraumatic stress disorder (PTSD) symptoms and fear of recurrence in breast cancer patients.

The cross-sectional study was conducted at Kasra Hospital and Cancer Research Center at Shahid Beheshti University of Medical Sciences in Tehran, Iran, from September to November 2022. A total of 220 female breast cancer patients completed questionnaires, including the Penn State Anxiety Questionnaire, PTSD Checklist for DSM-5, Fear of Cancer Recurrence Inventory), and Cancer Fatigue Scale. The data were analyzed in SPSS (version 27) and SmartPLS (version 4) software packages using the advanced statistical method of structural equation modeling.

The model fit indices were good (SRMR=0.6 and NFI=94). The results obtained from structural equation modeling pointed to the direct and significant effect of anxiety on PTSD (β=0.287; T=3.62; P<0.001), anxiety on fatigue (β=0.310; T=3.89; P<.001), fatigue on PTSD (β=0.390; T=5.31; P<.001), and fatigue on fear of cancer recurrence (β=0.274; T=3.73; P<.001). The non-significant impact of anxiety on fear of cancer recurrence (β=0.052; T=0.757; P=0.449) was in the framework of the conceptual model of the present study. It is worth noting that fatigue had a partial mediating role in the effect of anxiety on PTSD.

These findings suggest that fatigue can increase cancer-related PTSD and fear of cancer recurrence in breast cancer patients. Since early fatigue can increase the impact of cancer diagnosis and treatment on the performance and quality of life of these patients, the findings of the present study are effective for healthcare providers and breast cancer survivors. Future research should focus on the use of psychological interventions to reduce the psychological consequences of cancer for this growing population in Iran.